Following a surgery early Thursday morning, staff at Northside Hospital-Forsyth worked to clear the operating room for the next procedure, including opening a filter that just had been used to see what doctors removed from the patient.

Dr. Siddharth Patel examined what was found and explained that if any of the small, grain-sized debris had made it to the patient’s brain, it would have immediately caused a stroke.

On Thursday, Forsyth County News was invited to the hospital to observe a transcarotid artery revascularization (TCAR) procedure, a new minimally-invasive operation to clear blockages from carotid arteries in the neck.

- photo by Micah Green- photo by Micah Green
Northside is one of the only hospital systems in the state, and one of about 50 in the nation, to offer the procedure.

“The goal of the procedure is to reduce the chance of a major stroke,” said Patel prior to his 17th time performing the procedure. “Typically, what we do right now, the other two options would be surgery to open the blockage, scoop it out and then sewing it back together again – that’s called a carotid endarterectomy, which of course has associated risks with it.

“In higher risk patients, what we do is [transfemoral carotid artery] stenting, where we come up from the groin.”

Patel said TCAR offers “the best of both worlds.”

“You have surgical protection but the benefits of minimum invasiveness of stinting,” he said.

The procedure removes the blockage by making a small incision above the collarbone to place a tube on the artery, connecting to a system to direct the flow of blood away from the brain to divert debris, filtering the blood through the external system and returning it to the body through a second tube in the thigh.

Patel said the surgery is meant for those over 75 or who have other high-risk factors making other options unsafe. He recently successfully treated a then-96-year-old patient, the oldest in the world to have the procedure done.

- photo by Micah Green
“This procedure is reserved for people that are high-risk,” he said. “So, whether they’ve had major coronary disease that precludes them from being under general anesthesia, heart failure is one, severe COPD. Those are medical risks.

“There are also anatomical risks: if someone has had a lot of surgeries on their neck before, where you’re anticipating too much scar tissue, if they’ve had too much radiation before, if their other side is 100 percent blocked,” he said.

The Northside system was selected by Silk Road Medical, the company that develops and produces less invasive devises for carotid disease, to perform the procedure and is planned to be a training site for other hospitals.

“There is only one company that provides the equipment and the stinting for this,” Patel said. “They were quite impressed with our facility here at Northside, and once it becomes more commercially available and open to more people, they’d like us to become a training center where people come in and learn how to do it and take it back to their hospital.”